tailieunhanh - Chapter 110. Coagulation Disorders (Part 11)

Treatment with FFP is the most effective way to correct hemostasis in patients with liver failure. Infusion of FFP (5–10 mL/kg; each bag contains ~200 mL) is sufficient to ensure 10–20% of normal levels of clotting factors but not correction of PT or aPTT. Even high doses of FFP (20 mL/kg) do not correct the clotting times in all patients. | Chapter 110. Coagulation Disorders Part 11 Treatment with FFP is the most effective way to correct hemostasis in patients with liver failure. Infusion of FFP 5-10 mL kg each bag contains 200 mL is sufficient to ensure 10-20 of normal levels of clotting factors but not correction of PT or aPTT. Even high doses of FFP 20 mL kg do not correct the clotting times in all patients. Monitoring for clinical symptoms and clotting times will determine if repeated doses are required 8-12 h after the first infusion. Platelet concentrates are indicated when platelet counts are 10 000-20 000 mm3 to control an ongoing bleed or immediately before an invasive procedure if counts are 50 000 mm3. Cryoprecipitate is indicated only when fibrinogen levels are 100 mg mL dosing is six bags for a 70-kg patient daily. As noted above PCC infusion in patients with liver failure should be avoided due to the high risk of thrombotic complications. The safety of antifibrinolytic drugs to control bleeding in patients with liver failure is not yet well-defined and should be avoided. Acquired Inhibitors of Coagulation Factors An acquired inhibitor is an immune-mediated disease characterized by the presence of an autoantibody against a specific clotting factor. FVIII is the most common target of antibody formation but inhibitors to prothrombin FV FIX FX and FXI are also reported. The disease occurs predominantly in older adults median age of 60 years but occasionally in pregnant or postpartum women with no previous history of bleeding. In 50 of patients with inhibitors no underlying disease is identified at the time of diagnosis. In the remaining half the causes are autoimmune diseases malignancies lymphomas prostate cancer dermatologic diseases and pregnancy. Previous history of open surgery in which topical thrombin is used especially preparations containing bovine FV is sometimes associated. Bleeding episodes occur commonly into soft tissues and in the gastrointestinal or urinary tracts and skin. .